Typescript. / Thesis (Ed. D.) -- University of Hawaii at Manoa, 1988. / Bibliography: leaves 167-169. / Photocopy. / Microfilm. / xii, 169 leaves, bound 29 cm

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Bakgrund: Inom den kommunala hemsjukvården utförs många hälso- och sjukvårdsuppgifter på delegation av omvårdnadspersonal utan formell kompetens. Personalen har olika bakgrund avseende utbildning, erfarenhet och språkkunskaper. Syfte: Att beskriva omvårdnadspersonalens erfarenheter av att utföra delegerade arbetsuppgifter från distriktssköterska. Metod: Elva semistrukturerade intervjuer genomfördes våren 2017 med delegerad omvårdnadspersonal ur tre olika arbetsgrupper i en kommun i norra Sverige. Kvalitativ innehållsanalys med induktiv ansats användes som analysmetod. Resultat: Resultatet utmynnade i tre kategorier: ”Risker”, ”Förbättringsområden” och ”Framgångsfaktorer” utifrån tio subkategorier. Slutsats: Omvårdnadspersonalen önskar tydliga instruktioner och kontinuerlig kontakt med den sjuksköterska som gett delegering. En god kommunikation och nära samarbete främjer patientsäkerheten. Mer utbildning efterfrågades om olika läkemedel, biverkningar, diabetes och hjärt- och lungräddning. / Background: In the field of municipal home nursing, many health care services are carried out by delegation of nursing personnel without formal competence. The personnel have different backgrounds regarding education, experience and language skills. Aim: To deskribe unlicensed assistive/nursing/ personnel´s experience of performing delegated health care tasks. Method: Eleven semistructured interviews were undertaken in 2017 with unlicensed assistive/nursing personnel working in a municipality in the northern of Sweden. The applied method was qualitative contents analysis. Results: The study resulted in three cathegories “Risks”, “Improvement areas” and “Factors for success” from ten sub cathegories. Conclusions: The home care personnel wish for clear instructions and continuos contact with the delegating nurse. Safe communication promotes patient security. More education was requested about different medicines, side effects, diabetes and heart and lung resuscitation. / <p>Godkännandedatum: 2018-11-08</p>

Abstract not available

<p><strong>Introduction</strong></p><p>This thesis explores how we can increase patient safety through medicine management and administration in inpatient care units in somatic hospitals in Sweden and Norway by combining tools and systems which allows nurses to work safely, precicely, and efficiently whenever they are managing or administering medication to patients. </p><p></p><p><strong>Background</strong></p><p>Nurses have the formal, academic, and moral responsibility in medicine management and administration in hospitals (1). The nurse must ensure that the medication is given to the correct patient, that it is the correct kind of medication, correct form, correct strength, correct dose, correct administration method, and that it is given at the correct time (1). Regardless of these 7 points of control, adverse drug events still happen.</p><p></p><p><strong>Methodology</strong> </p><p>Through a human centered design approach this thesis explores design challenges and opportunities to how we can improve the medicine managment and administration process within somatic hospitals in Sweden and Norway.</p><p></p><p></p><p><strong>Result</strong></p><p>The final design proposal, Memo, suggests an ecosystem which make all medication traceable by incorporating a closed loop medicine management approach, making information accessible and consistent across digital and physical platforms, and having a  precise, accessible, and informative electronic medicine list. Memo eliminates risks of medicine errors by designing barriers within the system which make it harder for the nurse to make an error. The aim is to increase patient safety.</p><p>Memo is developed together with nurses and pharmacists from 3 different hospitals in Sweden and Norway.</p>

Text in English / The purpose of this study was to develop strategies to overcome the challenges in the management of large intensive care units (ICUs). Qualitative, research was conducted to explore and describe the challenges and needs experienced by the ICU managers and critical care nurses in the management of large ICUs. Data was collected through interviews. The study was conducted in two phases, that is, Phases I and II which involved compilation of evidence in preparation for development of the strategies and development of the strategies respectively. Two groups of critical care nurses participated in the steps of data collection in Phase I of the study. The unit managers participated in Phase I step 1 which was individual interviews and the critical care nurses not in the management role participated in Phase I, step 2 which was focus group interviews. Data was analysed using the descriptive analysis method of Tesch (1990). The study has highlighted the challenges and needs in the management of large ICUs, through seven themes that emerged from the findings. Ten strategies were developed to overcome the challenges and address the identified needs. The strategies have been presented as a contribution to literature. / Health Studies / D. Litt. et Phil. (Health Studies)

Research Questions: Research Question I: How does the material management process of medicine differ between a ward with, and without, an Automated Ward Solution (AWS)? Research Question II: How do time and costs differ in the material management process of medicine between a ward with, and without, an AWS? Research Question III: How has the instalment of a central storage affected the number of orders placed for wards? Purpose: The purpose is to map and compare the material management process of medicine between a ward with, and without, an AWS. Further the mapped processes will be timed, allocated costs by applying TDABC and then compared. The purpose is as well to describe how the instalment of a central storage has affected the frequency of orders placed for wards. Methodology: This project is a qualitative case study as the authors wished to understand the phenomena of having installed AWSs for medicine in a real context. The primary data was collected through interviews, observations and studying of documents; the secondary data was collected through scientific articles and literatures. The collected data answered the research questions with the help of process mapping and TDABC. Conclusion: In the created process maps it is found that the extensiveness of the different processes when compared are similar for both wards; however the allocated costs calculated through TDABC sometimes differ due to the involvement of the Pharmaceutical Unit as it carries a higher capacity cost per minute. Ward 5 can be assumed to have a higher security and accuracy due to the instalment of an AWS and by having laid more responsibility on the Pharmaceutical Unit. The AWS has however led to a larger waste for Ward 5 as it cannot return regular medicine anymore. This project could not directly connect the instalment of a central storage with reduced order lines; however it can be assumed that it has contributed to the decreased order lines placed.

Aim/Objectives: There were two aims; improving type II diabetes glycaemic control; and enhancing the role of community pharmacists by engaging them in type II diabetes medicine management. Methods: This quantitative study collected data from both community pharmacists and patients. In a premises survey, 426 self-administered questionnaires were distributed to community pharmacies. In a knowledge survey, 125 questionnaires were distributed to community pharmacists. In a clinical trial, 40 community pharmacies were randomly assigned to be control (18) and intervention (22) premises. Each pharmacy recruited 4 or 5 patients with type II diabetes. 225 patients were recruited and assigned to receive usual pharmacist care (n=100) or a pre-defined pharmacist intervention (n=125). Results: Community pharmacists had good knowledge of diabetes with average scores 21/29 (±3.18). The differences between control and intervention groups in patients' HbA1c and FPG changes were not significant. In the intervention group patients' diabetes knowledge was significantly improved (p=0.031). In the intervention group HbA1c and FPG improved significantly and in the control group FPG improved significantly and HbA1c did not. Patients' self-reported self-management activities improved significantly around blood glucose measurements (p < 0.001) and physical exercising (p=0.001). Attitudes around the value of tight control of diabetes improved (p < 0.001). Conclusion: The findings suggest that community pharmacists in Libya may have the ability to improve type II diabetes care. The primary outcomes were not improved in intervention versus control. The before/after analysis showed significant improvement in primary outcomes in the intervention group and also in one of the primary outcomes in the control group. Patients' self-reported self-care activities and attitudes improved significantly in the intervention group.

Text in English / The purpose of this study was to develop strategies to overcome the challenges in the management of large intensive care units (ICUs). Qualitative, research was conducted to explore and describe the challenges and needs experienced by the ICU managers and critical care nurses in the management of large ICUs. Data was collected through interviews. The study was conducted in two phases, that is, Phases I and II which involved compilation of evidence in preparation for development of the strategies and development of the strategies respectively. Two groups of critical care nurses participated in the steps of data collection in Phase I of the study. The unit managers participated in Phase I step 1 which was individual interviews and the critical care nurses not in the management role participated in Phase I, step 2 which was focus group interviews. Data was analysed using the descriptive analysis method of Tesch (1990). The study has highlighted the challenges and needs in the management of large ICUs, through seven themes that emerged from the findings. Ten strategies were developed to overcome the challenges and address the identified needs. The strategies have been presented as a contribution to literature. / Health Studies / D. Litt. et Phil. (Health Studies)

Aim/Objectives: There were two aims; improving type II diabetes glycaemic control; and enhancing the role of community pharmacists by engaging them in type II diabetes medicine management. Methods: This quantitative study collected data from both community pharmacists and patients. In a premises survey, 426 self-administered questionnaires were distributed to community pharmacies. In a knowledge survey, 125 questionnaires were distributed to community pharmacists. In a clinical trial, 40 community pharmacies were randomly assigned to be control (18) and intervention (22) premises. Each pharmacy recruited 4 or 5 patients with type II diabetes. 225 patients were recruited and assigned to receive usual pharmacist care (n=100) or a pre-defined pharmacist intervention (n=125). Results: Community pharmacists had good knowledge of diabetes with average scores 21/29 (±3.18). The differences between control and intervention groups in patients' HbA1c and FPG changes were not significant. In the intervention group patients' diabetes knowledge was significantly improved (p=0.031). In the intervention group HbA1c and FPG improved significantly and in the control group FPG improved significantly and HbA1c did not. Patients' self-reported self-management activities improved significantly around blood glucose measurements (p<0.001) and physical exercising (p=0.001). Attitudes around the value of tight control of diabetes improved (p<0.001). Conclusion: The findings suggest that community pharmacists in Libya may have the ability to improve type II diabetes care. The primary outcomes were not improved in intervention versus control. The before/after analysis showed significant improvement in primary outcomes in the intervention group and also in one of the primary outcomes in the control group. Patients' self-reported self-care activities and attitudes improved significantly in the intervention group.